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version Acute myeloid leukemia (AML) is cancer that starts inside bone marrow, the soft tissue inside bones that helps form blood cells. The cancer grows from cells that would normally turn into white blood cells. Acute means the disease develops quickly. Acute myeloid leukemia (AML) is a type of blood cancer. AML usually develops from cells that would turn into white blood cells (other than lymphocytes). Sometimes, though, it can develop from other types of blood-forming cells. Here is basic information about the symptoms, risk factors, survival rates, and treatments for AML. Acute myeloid leukemia starts in the bone marrow. This is the soft inner parts of bones. With acute types of leukemia such as AML, bone marrow cells don't mature the way they're supposed to. These immature cells, often called blast cells, just keep building up. You may hear other names for acute myeloid leukemia. Doctors may call it:

Acute myelocytic leukemia Acute myelogenous leukemia Acute granulocytic leukemia Acute non-lymphocytic leukemia

Without treatment, AML can quickly be fatal. Because it's "acute," this type of leukemia can spread quickly to the blood and to other parts of the body such as the following organs:

Lymph nodes Liver Spleen Brain and spinal cord Testicles

The expected outcome for acute myeloid leukemia depends on certain factors. And of course prognosis is better if your leukemia responds well to treatment. Your outlook is better if:

You are younger than age 60. You do not have a history of blood disorders or cancers. You do not have certain gene mutations or chromosome changes.

Risk Factors for Acute Myeloid Leukemia If something increases your risk of getting a disease, it's called a risk factor. Risk factors don't tell the whole story. For example, you can have few risk factors and still get a disease or have several and not get it. Acute myeloid leukemia risk factors include:

Smoking Exposure to certain chemicals such as benzene (a solvent used in oil refineries and other industries and present in cigarette smoke), certain cleaning products, detergents, and paint strippers Treatment with certain chemotherapy drugs used to treat other cancers, such as mechlorethamine, procarbazine, and chlorambucil -- especially when combined with radiation therapy Exposure to high doses of radiation Certain blood disorders, such as myeloproliferative disorders (for example, chronic myelogenous leukemia) Certain congenital syndromes, such as Down syndrome Being male

For most people, the cause of AML is unknown. There is not a way to prevent it, but you may reduce your risk by quitting smoking and avoiding exposure to chemicals. Symptoms of Acute Myeloid Leukemia If you have any of the symptoms mentioned below, it's important to have a doctor check them out right away to determine the cause. AML can cause a variety of signs and symptoms. Since the symptoms are often vague, they could be caused by other conditions. Symptoms include:

Fatigue Fever Loss of appetite or weight Night sweats

Many symptoms of acute myeloid leukemia are the result of a shortage of normal blood cells. That's because leukemia cells crowd out normal cells in the bone marrow. Symptoms of Acute Myeloid Leukemia continued... A shortage of red blood cells may cause symptoms of anemia including:

Fatigue or weakness Dizziness Feeling cold Light-headedness Headaches Shortness of breath

A shortage of normal white blood cells may result in:

Recurring infections Fevers

A shortage of blood platelets may cause symptoms such as

Lots of bruising for no clear reason Frequent or severe nosebleeds, bleeding gums, or other unusual bleeding such as from minor cuts

Depending upon where leukemia cells are present, other symptoms may include:

Bone or joint pain A full or swollen belly from leukemia cells in the liver or spleen Lumps or rashes in the skin Swollen, painful, bleeding gums Headache, trouble with balance, vomiting, seizures, or blurred vision Enlarged lymph nodes such as in the neck or groin, under arms, or above the collarbone (rare)

Treatment for Acute Myeloid Leukemia Because AML is a group of related diseases, treatment depends upon each subtype as well as on other factors. It is important to start treatment as soon as possible after diagnosis. You may have more than one type of treatment, including:

Chemotherapy, the use of anticancer drugs -- often two or three -- such as cytarabine, anthracycline drugs, 6-thioguanine, hydroxyurea, or prednisone. Radiation therapy, the use of high-energy radiation to kill cancer cells. This is not used often for AML but may be used to treat leukemia in the brain, bone, or testicles; before a stem cell transplant; or, in rare cases, to shrink a tumor that's pressing on the windpipe.

A bone marrow transplant, which involves use of high doses of chemotherapy and possibly radiation, followed by a transplant of bone-forming stem cells. Stem cells usually come from a donor. Or, less likely, they come from your own bone marrow or peripheral blood. If you cannot tolerate high doses of chemotherapy and radiation, lower doses may be used with a "minitransplant."

What are the survival rates for acute myeloid leukemia? The five-year survival rate overall is about 24%. Surviving at least five years indicates a good chance of long-term survival. Survival rates may be better now as this statistic reflects outcomes from 1999 to 2006. AML treatment consists of two parts: induction therapy and consolidation therapy, which are both done in the hospital. The goal of induction therapy is to achieve remission by:

Killing as many AML cells as possible Returning blood counts to normal over time Ridding the body of signs of disease for a long time

Even if remission is achieved, you will likely still need more treatment. Consolidation therapy attacks leukemia cells that common blood or marrow tests can't find. This therapy may include chemotherapy, which may be different drugs than those used earlier, and possibly a bone marrow transplant.

Acute Myelogenous Leukemia (AML) Acute myelogenous leukemia (AML) is a fast-growing cancer of the blood and bone marrow. In AML, the bone marrow makes many unformed cells called blasts. Blasts normally develop into white blood cells that fight infection. However, the blasts are abnormal in AML. They do not develop and cannot fight infections. The bone marrow may also make abnormal red blood cells and platelets. The number of abnormal cells (or leukemia cells) grows quickly. They crowd out the normal red blood cells, white blood cells and platelets the body needs. On this page: Acute myelogenous leukemia symptoms and diagnosis Treatment options for acute myelogenous leukemia

Chemotherapy for AML Bone marrow or cord blood transplant for AML Making treatment decisions

Acute myelogenous leukemia symptoms and diagnosis AML is the most common type of acute leukemia. More than 11,900 new cases occur in the United States each year, mostly in older adults. The average age of a person with AML is 65 years. Fewer than 10% of people with AML are children. Acute myelogenous leukemia is also called acute myeloblastic leukemia, acute myeloid leukemia, acute granulocytic leukemia or acute nonlymphocytic leukemia. Symptoms The symptoms of AML are caused by low numbers of healthy blood cells and high numbers of leukemia cells.

White blood cells fight infection. Low numbers can lead to fever and frequent infections. Red blood cells carry oxygen throughout the body. Low numbers can lead to anemia feeling tired or weak, being short of breath and looking pale. Platelets control bleeding. Low numbers can lead to easy bleeding or bruising and tiny red spots under the skin (petechiae). High numbers of leukemia cells may cause pain in the bones or joints.

A person with AML may feel generally unwell and run-down. He or she may also have other, less common symptoms. Diagnosis

AML is diagnosed when blood and bone marrow samples show a large number of leukemia cells. AML has eight subtypes, labeled M0 through M7. The subtypes are based on the type of blood cells affected. To find out the sub type and how well the leukemia might respond to treatment, the samples are looked at to find:

The number of healthy blood cells. The size and number of leukemia cells. The changes that appear in the chromosomes of the leukemia cells. This is called cytogenetics. Other genetic abnormalities, e.g., FLT3 mutation, N-RAS.

Doctors also examine the patient to find out if leukemia cells have spread outside the blood and bone marrow. Doctors may use a chest X-ray and an ultrasound of the abdomen to look at the organs and tissues inside. They may also use a test called a lumbar puncture (spinal tap) to find out whether there are leukemia cells in the fluid around the brain and spinal cord.

Treatment options for acute myelogenous leukemia AML can get worse quickly, so doctors usually begin treatment right away. To plan treatment, doctors look at a patient's risk factors (also called prognostic factors). Risk factors are patient and disease traits that clinical studies have linked to better or worse outcomes from treatment. Examples of risk factors are a patient's age and subtype of AML. To learn more about AML risk factors as well as how treatment options may differ for children or for adults older than age 60, see Risk Factors for Planning Treatment of AML. For a patient with AML, the treatment plan may include:

Chemotherapy drugs that destroy cancer cells or stop them from growing (described below). A bone marrow or cord blood transplant (described below). All-trans retinoic acid (ATRA) if he or she has the subtype of AML known as promyelocytic leukemia. Other newer treatments that were recently developed or are still being studied in clinical trials you can ask your doctor whether any newer treatments may be options for you.

Whichever treatment you and your doctor choose, you may be asked to be part of a clinical trial. Even standard treatments continue to be studied in clinical trials. These studies help doctors learn more about which treatments work best for which patients.

Chemotherapy for AML Induction chemotherapy For most patients, the standard first phase of AML treatment is induction chemotherapy. The goal of induction chemotherapy is to bring the disease into remission. Remission is when the patient's blood counts return to normal and bone marrow samples show no sign of disease (less than 5% of cells are leukemia cells). Induction chemotherapy is very intense. It usually lasts one week, followed by three or more weeks for the patient to recover from the treatment. Often two drugs are used:

Cytarabine (ara-C) An anthracycline drug such as daunorubicin (Daunomycin) or idarubicin (Idamycin)

Some patients may also be given additional drugs or different drugs. Patients who have the AML subtype promyelocytic leukemia also are given all-trans retinoic acid (ATRA). If one week of treatment does not bring a remission, treatment may be repeated once or twice. Induction brings a complete remission in:

About 70% to 80% of adults under age 60. About 50% of adults over age 60. More than 90% of children.

Successful induction chemotherapy destroys most of the leukemia cells, but a few will be left in the body. If these cells are not destroyed, they can cause a relapse of the disease. More treatment is needed to destroy the remaining leukemia cells. The next step may be consolidation chemotherapy or a transplant, depending on the treatment plan. Consolidation chemotherapy The second phase of chemotherapy is often called consolidation chemotherapy. The goal of consolidation chemotherapy is to destroy any remaining leukemia cells. A common treatment is high doses of cytarabine (ara-C) given in three or more cycles. Doctors may also use different drugs and schedules. Consolidation chemotherapy is used to treat many patients with AML. It is the standard treatment at first remission for adults with low-risk cytogenetic factors (changes in the chromosomes of leukemia cells), especially adults younger than age 60.

Bone marrow or cord blood transplant for AML For some patients, a bone marrow or cord blood transplant may offer the best chance for a long-term remission. A transplant is a strong treatment with risks of serious side effects, so it is not used for all patients with AML. A transplant is used when chemotherapy alone is unlikely to provide a long-term remission. Autologous transplant An autologous transplant uses blood-forming cells collected from the patient. If an autologous transplant is a treatment option for you, you will have blood-forming cells collected from your blood stream. The cells are usually collected after one or two cycles of consolidation treatment. The cells are frozen until you are ready for transplant. You may receive an autologous transplant soon after your induction therapy is completed, or your cells may be saved as a backup option in case you relapse after receiving consolidation chemotherapy. Autologous transplants have risks of serious side effects, but these risks are lower than for allogeneic transplants. However, a patient has higher risks of a leukemia relapse after an autologous transplant. This is because leukemia cells may be returned to the patient along with his or her blood-forming cells. Allogeneic transplant An allogeneic transplant replaces the abnormal cells in a patient's bone marrow with healthy bloodforming cells from a family member or unrelated donor or cord blood unit. An allogeneic transplant has a higher risk of serious side effects than consolidation chemotherapy or an autologous transplant. However, the risk of relapse is lower after an allogeneic transplant. Choosing a donor or cord blood unit If an allogeneic transplant may be an option for you, your doctor will do a test to find out your HLA tissue type. Your doctor will also test possible donors in your family to find out if they are a suitable match for you. In adults in good health with standard AML and a matched sibling, an allogeneic transplant may be considered after remission with induction therapy. If you do not have a suitable donor in your family, your doctor can work with the National Marrow Donor Program to search for an unrelated donor or cord blood unit for you from our Be The Match Registry and other registries around the world. To save time, your doctor may check for potential donors on the registry at the same time he or she is testing for donors in your family. The closeness of the donor match can affect a patient's chances of a good transplant outcome. In general, transplants using matched sibling donors have had the best results. However, outcomes for unrelated donor transplants have improved in the last decade. For some groups of patients, outcomes for sibling donor and unrelated donor transplants are similar.

Reduced-intensity and non-myeloablative transplants For some people with AML, an allogeneic transplant may offer the best chance for a long-term remission. However, more than half of people with AML are over age 60. Many people older than age 60 are unable to tolerate the intense treatment of a standard transplant. People with other health problems, such as heart disease or organ damage from previous chemotherapy, may also be unable to tolerate a standard transplant. An allogeneic transplant using less intense treatment may be an option for some of these patients. This type of transplant is called a reduced-intensity transplant or non-myeloablative transplant. Transplant success rates Transplants have risks of serious complications, but a transplant offers some patients the best chance for a long-term remission. If transplant is an option for you, your doctor can talk with you about the possible risks and benefits of a transplant. For statistics showing patients' results after transplant, see AML Transplant Outcomes.

Making treatment decisions AML is an acute disease that can get worse quickly. Most patients begin treatment with induction chemotherapy soon after diagnosis. Many patients reach remission, but relapse of AML is common. All patients need a second phase of treatment to try to prevent relapse. The second phase of treatment is based on a patient's risk factors. (For more information, see Risk Factors for Planning Treatment of AML.) It is important to discuss your risk factors and your treatment options with a doctor who is experienced in treating AML. Planning for a possible transplant All patients with AML may want to talk with their doctors about including the possibility of a transplant in their treatment plan. A transplant may be the first choice or it may be a backup plan. When transplant is not the first treatment, early planning may allow for more flexibility in treatment options and a quicker transplant later, if it is needed. In general, to prepare for the possibility of transplant:

Patients with AML should be HLA tissue typed at diagnosis. Patients should be referred to a transplant doctor for consultation at an appropriate time based on risk factors. Family members who might be suitable donors should be tested at the same time as the patient or soon after. Doctors can take an early look at potential unrelated donors and cord blood units on the Be The Match Registry as soon as they know the patient's HLA tissue type. This first look is free of charge. Patients who have no suitable related donor and few potential unrelated donors may want to discuss storing their own blood-forming cells for a possible autologous transplant.

The only patients who may not benefit from this planning are those who would clearly be unable to tolerate even a reduced-intensity transplant. Some older patients and patients who have organ damage or other health problems may be unable to tolerate a transplant. If you want to consider a transplant, a transplant doctor can examine you to see whether a transplant is a good option. It is important to talk about your treatment options with a doctor who is experienced in treating AML. Your doctor can discuss your specific risk factors and treatment options with you. For more information to help you talk to your doctor about whether a transplant is an option for you, you can share the referral guidelines (PDF) from the Physician Resources section of this Web site with your doctor. More information on AML You can get further information about AML from disease-specific organizations, such as:

Leukemia and Lymphoma Society AML: http://www.lls.org/#/diseaseinformation/leukemia/acutemyeloidleukemia/ American Cancer Society: What is acute myeloid leukemia?: http://www.cancer.org/cancer/leukemia-acutemyeloidaml/index National Cancer Institute: Adult AML (PDQ): Treatment: http://www.cancer.gov/cancertopics/pdq/treatment/adultAML/patient

For other organizations that offer information and resources, see Organizations That Can Help: A Searchable Directory. Contributing editors C. F. LeMaistre, M.D., Southwest Texas Methodist Hospital, San Antonio, Texas Paul Shaughnessy, M.D., Texas Transplant Institute, San Antonio, Texas Anthony S. Stein, M.D., City of Hope National Medical Center, Duarte, Calif. http://bethematch.org/Patient/Disease_and_Treatment/About_Your_Disease/AML/Acute_Myelogenous_ Leukemia_%28AML%29.aspx

Risk Factors for Planning Treatment of AML Risk factors are patient and disease characteristics that clinical studies have linked to better or worse outcomes from treatment. Risk factors are also called prognostic factors. Doctors look at risk factors to try to predict how well a patient's disease will respond to treatment. This page focuses on some of the risk factors doctors may use to plan treatment for acute myelogenous leukemia (AML). For a more complete overview of AML symptoms and treatment options, see Acute Myelogenous Leukemia (AML). On this page: Risk factors doctors may consider Cytogenetic factors

High-risk factors for adults Children with AML Adults age 60 and older

Risk factors doctors may consider For acute myelogenous leukemia (AML), doctors look at risk factors to try to predict how well a patient's disease will respond to chemotherapy, the standard first treatment. Patients with low-risk factors have a good chance of reaching long-term remission with chemotherapy alone. For patients with certain highrisk factors, a bone marrow or cord blood transplant (also called a BMT) may offer the best chance for a long-term remission. Risk factors that doctors may look at when planning treatment for AML include:

The patient's age (see discussion below) Changes to the chromosomes (cytogenetic factors explained below) The subtype of AML Whether the patient had a blood disorder, such as myelodysplastic syndrome, before developing AML Whether the patient has received chemotherapy in the past Whether the AML has been treated before and relapsed Whether leukemia cells have spread to the central nervous system (brain and spinal cord) How well AML responds to early chemotherapy treatments Whether the patient has other health problems, such as diabetes or heart disease, that can affect his or her ability to tolerate some treatments

Cytogenetic factors Cytogenetic factors are changes in the chromosomes of leukemia cells.

There may be more or fewer chromosomes than normal. Part of one chromosome may move to another (chromosome translocation).

There are many chromosome changes that can occur with AML. Some changes are linked with better outcomes (low-risk changes) and others are linked with worse outcomes (high-risk changes). If you have AML, ask your doctor to explain your cytogenetic risk factors to you.

Examples of low-risk cytogenetic changes for AML include a translocation between chromosomes 15 and 17, a translocation between chromosomes 8 and 21, and certain changes to chromosome 16. Examples of high-risk cytogenetic changes for AML include changes to chromosome 5 or chromosome 7. Example of high-risk genetic change, FLT3 positive Example of low-risk genetic change, NPM 1 positive

High-risk factors for adults The National Marrow Donor Program (NMDP)* and American Society for Blood and Marrow Transplantation (ASBMT) recommend adult patients with AML be referred to a transplant doctor for consultation if they have any of the following high-risk factors:

Previous myelodysplastic syndrome or other blood-related disease AML that may have developed because of previous chemotherapy treatments No remission after induction treatment High-risk cytogenetics refer at first remission Relapse refer at second or later remission

Complete NMDP and ASBMT recommendations are available in the Physician Resources section of this website: Recommended Timing for Transplant Consultation (PDF). *The NMDP, which operates Be The Match, also conducts research to learn how to improve patient outcomes.

Children with AML Treatment for children age 17 or younger is similar to treatment for adults, but there are some differences. Children have different risk factors than adults. They also have a higher overall survival rate about

50% to 60%. Children also generally have a better chance of a good outcome from an allogeneic transplant, so transplant may be used more often for children with AML than for adults. The NMDP and ASBMT guidelines Recommended Timing for Transplant Consultation (PDF) recommend children with AML be referred to a transplant doctor for consultation if they have any of the following high-risk factors:

If the child is 2 years old or younger when diagnosed with AML If induction chemotherapy does not bring a remission If the leukemia cells show only one chromosome 5 or chromosome 7 (high-risk cytogenetic factors) As soon as the child reaches a first remission if he or she has a suitable sibling donor At a second remission after a relapse using either a related or unrelated donor or cord blood unit

Children have a higher risk than adults of leukemia spreading to the central nervous system (brain and spinal cord). Most children are treated to prevent this spread. Treatment is usually intrathecal chemotherapy injecting chemotherapy drugs into the spinal fluid. Treatment may also include radiation therapy to the head.

Adults age 60 and older More than half of people diagnosed with AML are age 60 or older. These older adults are more likely than younger adults to have high-risk disease factors. Older adults are less likely to respond well to treatment and may be less able to tolerate some treatments. Only 5% to 15% of adults age 60 or older are likely to survive without relapse for the long term. However, many factors affect a person's chances of long-term remission, so it is important to talk with your doctor about your own situation. If you are age 60 or older, it is a good idea to talk with your doctor about a range of treatment options. Ask about the chances of long-term remission, possible side effects and the quality of life you can expect with different treatments. It is important to have complete information so that you and your doctor can choose an approach that is right for you. Options may include:

Standard treatment options chemotherapy or a transplant. To learn about these standard treatment options, see Acute Myelogenous Leukemia (AML). Reduced-intensity transplant Many adults age 60 and older may be unable to tolerate a standard transplant, but a reduced-intensity transplant may be an option. Other newer treatments recently developed and/or being studied in clinical trials. Supportive care to maintain a good quality of life without trying to bring the AML into remission. Supportive care may include antibiotics to prevent infection and transfusions of red blood cells and platelets.

Causes Acute myeloid leukemia (AML) is one of the most common types of leukemia among adults. This type of cancer is rare under age 40. This article focuses on AML in adults. AML is more common in men than women. Persons with this type of cancer have abnormal cells inside their bone marrow. The cells grow very quickly, and replace healthy blood cells. The bone marrow, which helps the body fight infections, eventually stops working correctly. Persons with AML are more likely to have infections and have an increased risk for bleeding as the numbers of healthy blood cells decrease. Most of the time, a doctor cannot tell you what caused AML. However, the following things can lead to some types of leukemia, including AML:

Blood disorders, including polycythemia vera, thrombocythemia, and myelodysplasia Certain chemicals (for example, benzene) Certain chemotherapy drugs, including etoposide and drugs known as alkylating agents Exposure to certain chemicals and harmful substances Radiation Weakened immune system due to an organ transplant

Problems with your genes may also play a role in the development of AML. http://www.nlm.nih.gov/medlineplus/ency/article/000542.htm